Vascular surgery: cerebral hyperperfusion after endarterectomy: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Vascular surgery: cerebral hyperperfusion after endarterectomy

Sample item

Three days after endarterectomy for a tight symptomatic carotid stenosis, a hypertensive man develops severe ipsilateral headache and a focal seizure but no new limb weakness. Duplex shows a widely patent artery. What is the most likely cause?

AEarly restenosis with thrombus inside the endarterectomy siteBCerebral hyperperfusion from loss of autoregulation after flow is restoredCEmbolic occlusion of the ipsilateral middle cerebral arteryDCompression of the airway and vessels by a neck haematoma

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Cerebral hyperperfusion from loss of autoregulation after flow is restored

In a long-standing tight stenosis the distal vessels are maximally dilated. After endarterectomy the sudden high flow, helped by uncontrolled hypertension, causes headache, seizures and sometimes haemorrhage. Strict blood pressure control is the key preventive and treatment measure.

Option by option

A. Early restenosis with thrombus inside the endarterectomy site
A patent artery on duplex argues against thrombus or restenosis, and restenosis does not appear within days.
B. Cerebral hyperperfusion from loss of autoregulation after flow is restored (correct)
Correct. Distal vessels cannot constrict at once, so flow becomes excessive, causing headache and seizures.
C. Embolic occlusion of the ipsilateral middle cerebral artery
Embolic occlusion would produce a focal neurological deficit such as weakness rather than headache and seizure.
D. Compression of the airway and vessels by a neck haematoma
A neck haematoma causes swelling and airway compromise, and would not give a headache with a seizure.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Cerebral hyperperfusion from loss of autoregulation after flow is restored. In a long-standing tight stenosis the distal vessels are maximally dilated.

Why is "Early restenosis with thrombus inside the endarterectomy site" not the answer?

A patent artery on duplex argues against thrombus or restenosis, and restenosis does not appear within days.

Why is "Embolic occlusion of the ipsilateral middle cerebral artery" not the answer?

Embolic occlusion would produce a focal neurological deficit such as weakness rather than headache and seizure.

Why is "Compression of the airway and vessels by a neck haematoma" not the answer?

A neck haematoma causes swelling and airway compromise, and would not give a headache with a seizure.

What concept does this question test?

It tests Vascular surgery: cerebral hyperperfusion after endarterectomy in General Surgery. After endarterectomy the sudden high flow, helped by uncontrolled hypertension, causes headache, seizures and sometimes haemorrhage. Strict blood pressure control is the key preventive and treatment measure.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Vascular surgery: cerebral hyperperfusion after endarterectomy?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.